AGE FACTORS IN LASER TREATMENT OF VITREOUS EYE FLOATERS

AGE FACTORS IN LASER TREATMENT OF VITREOUS EYE FLOATERS

AGE IS AN IMPORTANT FACTOR IN PREDICTING IF YOU ARE A CANDIDATE FOR TREATMENTWhen we are firt contacted by someone out of the area with a description of their eye floater problem, it is usually followed by the question “Do you think I’m a candidate for treatment?“. Our first question to them is: “How old are you?“. Without knowing anything else, the age of the floater sufferer is the most important predictor of the type and location of the eye floater and consequently the potential for candidacy for treatment with the YAG laser.

Common vitreous degeneration, resulting in the subjective awareness of eye floaters, is not a well studied topic in the field of ophthalmology. Particularly regarding the types of floaters in younger people, which will be explained below. Fortunately, Dr. Johnson does not need to know why or how the floaters formed in their particular situation, but he does need to know what can or cannot be safely and predictably successfully treated. Please read through the following generalizations, but understand that there is overlap of characteristics and the age groupings are broad generalizations.

THE YOUNGEST GROUP: THE TEENS TO THE EARLY 30’sIn this medical practice, the youngest group is the most frustrating group to work with. They do have real vitreous floaters as defined by some condensation of the otherwise and preferably clear vitreous fluid. Their floaters tend to be microscopic filaments, threads, and small clumps and more important is that they are very consistently physically located too close to the retina to safely and successfully treated with the YAG laser.

The YAG laser that Dr. Johnson uses in treating floaters has a very specific focal point where all the energy is focused. That focused energy needs to be kept away from the delicate structures of the eye, such as the lens towards the front, and the retina and optic nerve in the posterior portion of the eye. The floaters in young people tend to sit less than 1-2 millimeters from the retina. Any movement of the floaters tends to be translational and not away from the retina. So although Dr. Johnson uses the eye movements to his advantage, these fine, delicate and microscopic floaters generally do not move away from the retina. In addition, because these floaters are so close to the retina, the shadows cast on to the retina are usually quite distinct which makes them so bothersome to the patient. The laser operator has many more optical obstacles in his way. The light reflected from these microscopic entities has to pass through many optical tissues as well as multiple lens elements in the microscope before they can be seen. Floaters in young people are often something that the patient sees, but the doctor doesn’t see. It is impossible to simply just increase the magnification. Microscopes don’t work that way.

So here’s the question that we are asked by young patients over and over again: “Do you think I’m a candidate for treatment?” My usual answer is “probably not based on your age alone“. That said, there have been some notable exceptions of younger patients that I have been able to treat. But these situations are exceptional. Dr. Johnson will not turn any one away from the door because of their age, but we feel it is simply being respectful to convey the statistical likelihood as to the potential for treatment in younger patients. Ultimately, it does take an in-person evaluation to determine it for sure. READ OUR FAQs FOR YOUNG PEOPLE WITH EYE FLOATERS

THE IN-BETWEEN AGE GROUP: 30-45 YEARS OLDIn our experience, age group commonly has generally clear vitreous fluid with multiple, cob-web like strands of condensed vitreal collagen. These strands (or groups of strands) typically reside in the posterior 1/3 of the globe. They move quickly like they are tethered by elastic fibers. In other words, they will move across or near the central vision with head movement, then return to its preferred, stable position.

As far as the “treatability” of these floaters, it is difficult to predict. They are more treatable than the typical 20 year old, but not as treatable as a group compared to a 60 year old who probably has much more material, mass, and volume to treat. In addition, the fibers tend to be fairly dense and ‘rubbery’, requiring good energy delivery which is sometimes difficult working in the posterior 1/3 as well as peripheral regions of the vitreous space.

That all said, we have enjoyed some notable successes in this age group with greater than 50% treatability and success. We find that many of these otherwise healthy patients with long careers ahead of them do appreciate the improvement in the quality of vision when they are treatable.

THE OLDER AGE GROUP: 45 AND OLDERThe age group that is by far the most successfully treated is the older patient. This group makes up the bulk of our patient base. They have often experienced a posterior vitreous detachment (PVD) or have more widespread degeneration of the vitreous larger clumps and masses.

The vitreous detachment may occur quite rapidly as there is a posterior movement and shift of this fluid. As this occurs, the vitreous body moves forward separating from the retina. The patient may experience a sudden onset of a large floater, or multiple scattered floaters, or thousands of small round specks scattered all throughout the eye.

Weiss Ring Floaters
A Weiss ring floater is a particular sub-type of floater that is always associated with a PVD, but a PVD does not necessarily produce a Weiss ring floater. These floaters are classically ring-shaped, but quite often they are not. These floaters are the most consistently, predictably, safely and successfully treated floaters.

Treatability of Older Patients The good news is that even though the floaters associated with a PVD are typical larger and more extensive than with the younger age groups, these floaters are more successfully treated. They are usually clustered away from the critical eye structures (retina and lens), and the density of the Weiss ring-derived floaters absorb the laser energy readily and are definitively vaporized. There is some fragmentation of the floater into microscopic pieces that may benefit from further treatment or they may be so small as to be optically invisible. As with all patients, the other, cloud-like floaters that may also be present can be treated, but tend to have more of a tendency to regress or reform. This effect is described in detail on the Expectations of Laser Treatmentpage which may require more overall treatment effort.